1588686471 NPI number — SAMRET YAUKOOLBODI MD

Table of content: SAMRET YAUKOOLBODI MD (NPI 1588686471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588686471 NPI number — SAMRET YAUKOOLBODI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAUKOOLBODI
Provider First Name:
SAMRET
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588686471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HIGH ST
Provider Second Line Business Mailing Address:
STE B252
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-852-1977
Provider Business Mailing Address Fax Number:
716-859-7388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-852-1977
Provider Business Practice Location Address Fax Number:
716-859-7388
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  137351 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00025409601 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5608983 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: CRDRA1373513 . This is a "WORKERS COMPENSATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00025409602 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000525482004 . This is a "BLUE SHIELD WESTERN NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00486508 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300122352 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com